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Evidence summaries

Taxanes for Adjuvant Treatment of Early Breast Cancer

Taxanes are effective as adjuvant chemotherapy regimens for improving overall and disease-free survival for women with operable early breast cancer compared to non-taxane regimens. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 29 studies involving a total of 41 911 women. Taxane-containing regimens improved overall survival (OS) and disease-free survival (DFS) compared to chemotherapy without a taxane (table T1). When a taxane-containing regimen was compared with the same regimen without a taxane, the beneficial effects of taxanes persisted for OS (HR 0.84, 95% CI 0.77 to 0.92; P < 0.001; 7 studies, n=10 842) and for DFS (HR 0.84, 95% CI 0.78 to 0.90; P < 0.001; 7 studies, n=10 842). Preliminary subgroup analysis by lymph node status showed a survival benefit with taxane-containing regimens in studies of women with lymph node-positive disease only (HR 0.83, 95% CI 0.78 to 0.88; P < 0.001; 17 studies, n=22 055) but less benefit in studies of women both with and without lymph node metastases or with no lymph node metastases. Taxane-containing regimens also improved DFS in women with lymph node-positive disease (HR 0.84, 95% CI 0.80 to 0.88; P < 0.001; 17 studies, n=22 055), although the benefit was marginal in studies of women both with and without lymph node-positive disease and was not apparent in studies of women with lymph node-negative disease. Taxanes resulted in a small increase in risk of febrile neutropenia and in a large increase in grade 3/4 neuropathy, but little or no difference in cardiotoxicity (table T1).

Taxane-containing chemotherapy vs any chemotherapy without taxane for early breast cancer

OutcomeRelative effect(95% CI)Risk with control - any chemotherapy without taxanesRisk with intervention -taxane-containing chemotherapy (95% CI)of participants(studies)Quality of the evidence
Overall survival:Low baseline risk of death Follow-up: range 5 years to 10 yearsHR 0.87(0.83 to 0.92)80 per 100070 per 1000(67 to 73)39 180(27) High
Overall survival:High baseline risk of death Follow-up: range 5 years to 10 years200 per 1000176 per 1000(169 to 184)
Disease-free progression Low baseline risk of recurrenceFollow-up: range 4 years to 10 yearsHR 0.88(0.85 to 0.92)140 per 1000124 per 1000(120 to 130)41 909(29) High
Disease-free progression high baseline risk of recurrenceFollow-up: range 4 years to 10 years320 per 1000288 per 1000(280 to 299)
Febrile neutropeniaFollow-up: 3 to 7 yearsOR 1.43(0.89 to 2.31)56 per 100078 per 1000(50 to 120)34 154(23) Moderate
Neuropathy (including grade 3/4 sensory or motor neuropathy, or both)Follow-up: 3 to 7 yearsOR 6.89 (3.23 to 14.71)6 per 100037 per 1,000(18 to 76)31 033(22) Moderate
Cardiotoxicity (including grade 3/4 and congestive cardiac failure)Follow-up: 3 to 10 yearsOR 0.87(0.56 to 1.33)9 per 10008 per 1000(5 to 12)32 894(23) Moderate

    References

    • Willson ML, Burke L, Ferguson T et al. Taxanes for adjuvant treatment of early breast cancer. Cochrane Database Syst Rev 2019;(9):CD004421. [PubMed]

Primary/Secondary Keywords